Combatting the 'dragon'

By John Howell
Posted 3/22/18

By JOHN HOWELL The numbers are hard to pin down, but reports from several sources would indicate that opioid-related overdose deaths are down and may be on the decline. In a meeting Thursday with Rhode Island Secretary of Health and Human Services Eric

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Combatting the 'dragon'

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The numbers are hard to pin down, but reports from several sources would indicate that opioid-related overdose deaths are down and may be on the decline.

In a meeting Thursday with Rhode Island Secretary of Health and Human Services Eric Beane, Kent Hospital reported it did not record a single death from an overdose between November and February, although, based on the last year’s ratio of seven deaths per 100 over dose admissions, the hospital could have expected to have eight deaths.

Warwick Police Captain Joseph Hopkins, who heads the Warwick Opioid Collaborative, however, points out there were two overdose deaths in Warwick during the month of February. He said it’s difficult to come up with the numbers between the agencies from police, rescue, state and the hospitals dealing with the situation.

Hopkins agrees that overdoses and deaths related to overdoses are down, but measured it by adding, “It’s nothing to get excited about.”

Nonetheless, it seems headway is being made.

According to statistics from the Centers for Disease Control, the 314 opioid overdose deaths recorded in Rhode Island for 2017 is down from 336 the year before. Data compiled by the CDC from July of 2016 to September 2017 on 45 different states regarding opioid overdoses showed decreases in overdose deaths in Rhode Island, as well as Massachusetts and New Hampshire. The Northeast region, however, showed an increase of 21 percent.

But while these developments are positive signs, they were not cause for celebration last Thursday as Beane visited Kent. He was here to learn firsthand what the hospital is doing and how that might be replicated. Beane heard how the Kent Emergency Department distributed 140 narcan (naloxone) kits to patients who had been admitted for an overdose upon their discharge. He also heard of the hospital’s effort to create a safety net and medication-assisted treatment for patients once they leave the hospital. It’s much more than handing out a lifesaving kit to someone who may return to taking opioids or narcotics.

Communication and engagement are critical, says Dr. Peter Graves, chief of emergency medicine at Kent.

“I think that’s the big opportunity in the state and the hardest thing at the state level to deal with – how do we engage with these people a week or two or a month later when they may be in a better frame of mind to receive some of these referrals for more definitive care for recovery,” he said.

“One of the frustrating things for us has always been we can give these patients all the paperwork in the world and make phone calls on their behalf and have recovery coaches come speak with them, but they just might not be in the right mindset to receive those advances and to avail themselves of the opportunity for more definitive recovery down the road,” he said.

Dr. James Fanale, president and CEO of Care New England, could relate. He talked about his two sons and their fight to overcome addiction. His message is not to give up no matter how many times they may give in to their addiction.

“There’s all sorts of reasons why that happens. With that said, I think constant, constant, constant availability of recovery coaches and people like that throughout the region provides more opportunity for people to connect,” he said. Fanale thinks the more contacts the better, suggesting they begin as early as 8th grade. “That’s when these minds are beginning to be developed,” he said.

“I think patients hear and see what we’re offering so they know Kent Hospital is a safe place to go, and if I need help I know I can go there and ask because they’ve put all these measures in place and they’re offering these services that I wouldn’t know where to get otherwise,” said Brydie Thomasian of Kent’s social services. “So if they are at a point where they want help or are considering treatment, they know Kent is a place to go, and I think that makes a huge difference for the community.”

Graves said that the use of narcan is part of the puzzle and, while it may save a life, it doesn’t necessarily get people involved in definitive recovery efforts. As of last November, Kent started using medication-assisted treatment using buprenorphine, a strong painkiller related to morphine, to ameliorate some of the acute withdrawal symptoms.

“Now we can start them on essentially Suboxone [the commercial name for buprenorphine combined with naloxone] and get them a same or next day appointment at Butler Hospital or any number of different facilities in the region so they can get that definitive care,” he said.

In a telephone interview, Department of Health spokesperson Joseph Wendelken attributed the state’s decline in opioid-related deaths is “probably the result of many factors,” including that Rhode Island has a “very comprehensive plan in place.”

He pointed to a state law that requires hospitals to give people who come in after overdosing a discharge plan that includes education, connection to a recovery counselor, connection to a doctor and overdose reversal drugs.

He also said there is an education program run at the ACI that has resulted in a 61 percent decrease in post-incarceration deaths from overdoses.

He said that the state has “updated our regulations for the treatment of pain and the prescription of pain medication that’s not specifically for acute pain,” which he added has “brought structure to the prescribing environment.”

Asked what he is seeing, Mayor Scott Avedisian talked of the work being done by the Warwick Opioid Collaborative.

He said the issue of the opioid epidemic is being taken up at neighborhood association meetings attended by community police. He pointed to the Norwood Neighborhood Association that has worked with police and the U.S. Attorney General on an April 11 showing of the documentary “Chasing the Dragon” at the Crowne Plaza. Hopkins said the Crowne, at no charge, is hosting the film showing and panel discussion to follow. The event is scheduled to start at 7 p.m.

On the legal front, where Warwick has joined more than 20 other Rhode Island municipalities that have joined hundreds of municipalities in a lawsuit against the distributors of opioids and corresponding pharmaceutical companies that produce them, Avedisian sees the possibility of a settlement which, if it was to happen, could provide the city with resources to develop programs and extend services with Bridgemark, the Kent Center and other agencies. He believes there has been a decrease in the prescription of opioids. Lt. Gov. Daniel McKee is coordinating the lawsuit with Rhode Island attorney Eva Mancuso

Beane, too, acknowledged a decline in overdose deaths.

“This is great and this is really encouraging, and I know a lot of work has gone into modernizing the practices and adapting to meet the demands of this challenge,” he said.

“When you’re engaged with these populations, we’re already dealing with individuals in crisis, so we also have to be thinking upstream about prevention – avoiding drug use in the first place, but also looking at prescribing practices with opioids,” he said.

Hopkins sees education and working with those who have overdosed as keys to addressing the epidemic.

As part of the education package, the collaborative has developed brochures listing services and recovery coaches that he is looking to get into the hands of friends and family, as well as those who have overdosed. The department is also working with the city’s hotel community in educating them to recognize the indicators of drug use and the dangers of even coming in contact with carfentanil, which is 5,000 times more potent than heroin.

In addition, Hopkins pointed to the department’s wellness program where every week off-duty officers, dressed in plain clothes, “hook up” with Maureen Gouveia, mental health liaison for Warwick Police and reach out to those who have overdosed and are back out on the street. The aim, he explained, is to connect these people with a recovery coach or, at the very least, to let them know “we’re here, call us if you want treatment.”

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